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April 26, 2014

The Next Meeting with the New Member

James was happy to see us on Thursday
and had lots of questions. His concern was the reduced amount of
carbohydrates. Allen explained that he would use his meter to
determine if the amount was too low or too high. Allen asked James
when he had started his evening meal. James said about an hour
earlier and Allen asked Jill if that was about right. Jill gave the
time and Allen suggested that he test then. Allen recorded the time
and meter reading. Allen said he would test 15 minutes later.

James was a little anxious, but I told
him that by testing, he would have a better idea. Allen confirmed
that and asked Jill if she had recorded the carbs James has consumed.
Jill said that she had not, but could figure it out. I told her
that would be good and would help us in matching the testing. I
continued that we would show both of them how to maintain a food log
which would help James in determining the insulin that he would need.

I started on the food log for them and
Allen kept track of the time and had James test in 15 minutes.
Again, he recorded the time and reading and said he would test again
in 15 minutes since the last reading was higher than the one-hour
postprandial reading. Allen explained what we were looking for and
why. He told James that the recording and time was important because
we were looking for the downturn in his blood glucose levels.

Jill and I continued working on the
food log and in about 30 minutes had it complete for the day. James
added a couple of items from lunch that Jill did not know about. At
that time, Allen asked James to test again. Allen recorded the time
and meter reading and said it is the same as the last reading, so we
would do one more test and that could possibly be the last for the
evening meal.

I asked Jill if she had an idea of the
food for the next day. She wrote out the breakfast menu and what she
would prepare for lunch. We calculated the carbs and James stated
that was too low. Allen said we are only suggesting, but if you want
to manage diabetes, you would be wise to consider our suggestions.
Allen said you can lie to us, your wife, and even Dr. Tom, but the
A1c will still give Dr. Tom an idea if you are telling the truth.
Even trying to lie to yourself will not help in managing your
diabetes.

Allen said it is time to test again.
He recorded the time and reading and pointed out the changes to
James. This reading was down sharply from the previous reading.
Allen said this suggests that the high reading probably occurred
between one-hour and 15 minutes and one-hour and 30 minutes. It is
unusual for the two readings to be the same and that is the reason
for testing at one-hour and 45 minutes. If the reading at one-hour
30 minutes had been lower, the last test would not have been needed.

Now, Allen asked what his before meal
reading was. James said he did not remember. Allen asked if he
would download his meter and print out today's readings. James hesitated
and Allen said it is necessary when you won't record your readings on
a pad of paper. While they were doing this, I talked with Jill and
checked how many carbs he had for the day. He had just in excess of
130 carbs and this was more than the suggested range. Jill had her
laptop and I asked her to read the email I had sent. She said she
had and the links were interesting. I asked if she had a recipe that
they liked and did not have the nutritional data from an old
cookbook.

She reached for the cookbook and opened
it. I had her join this site and then go to this page. She entered
the ingredients and had the nutrition information. Jill said that
was easy and I commented that it was not an accurate list of
nutrients, but close enough to help in carb counting and with the
blood glucose readings, they would know how close they were. I took
time to go into some of the variables and said I would send her an
email of where to read about more.

I told Jill that if they kept up the
food log and carb count for the next few months, they would start to
see patterns and this would help encourage her husband better to
manage his blood glucose.

Allen and James came in then and Allen
said James needs to work on recording his blood glucose readings and
keeping them for the day instead of downloading his meter so often.
Allen said his readings from before eating to about the highest post
prandial was over 70 mg/dl. I asked James if he understood what this
told him. He said Allen had said that this was too high based on the
number of carbs his wife had calculated for his food. I said this
should indicate that you did not inject the correct dose of insulin
and needed to increase it by the formula Dr. Tom had given him. I
then told James that being new to insulin and needing to lose 15
pounds, reducing the number of carbohydrates was important to prevent
weight gain. If he followed our suggestions he would not gain weight
and would lose weight slowly. In a couple of weeks he would be
adjusted to lower carbs and would not even notice the reduced number.

Jill said that tonight was valuable for
her and she was beginning to understand more of what was involved and
hopefully between the two of them they could together work at
improving his diabetes management. Allen said James is still being
lazy in the tasks he needs to record and wanting technology to do all
his work. Jill said she would work at encouraging him and I told
Jill she needed to learn at the same time, but the responsibility
still was his, as it was his diabetes, and not her diabetes.

With that, Allen and I said goodbye and
stated we were available if they had questions. When we were
outside, Allen said he would talk to Tim.

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About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.